RECOMMENDATION #1
UH JABSOM/HMEC recommends that UH JABSOM and the legislature work with vital stakeholders to identify options for funding GME and the return on investment to the state of Hawai‘i in funding GME.

RECOMMENDATION #2
UH JABSOM/HMEC recommends that the 2018 State Legislature assess the advisability and feasibility of an annual GME Appropriation to fund HMEC designated residency/fellowship programs with a particular emphasis on primary care.

RECOMMENDATION #3
UH/HMEC recommends that the 2018 State Legislature and State Executive Branch support the State Department of Human Services and UH JABSOM to work together to develop a State Medicaid GME Matching program to augment GME funding.

RECOMMENDATION #4
UH/HMEC recommends that the 2018 State Legislature, UH JABSOM, the Hawai‘i Medical Association and other stakeholders explore potential remedies or reforms to protect residents and fellows from being named in malpractice suits while they are in a formal training program and providing care under the supervision of a fully licensed attending physician.

Minutes were reviewed and a correction made to Mark Mugiishi’s role description from representing a hospital to representing the health professions community. Otherwise, minutes approved as is from last meeting on 1/22/18. Motion to approve came from W. Dubbs and second by T. Seto. Motion to approve carried unanimously. No opposed and no abstentions.

NA.

2. Chair Report
Dean J. Hedges

Announcements: Dean Hedges announced that to date, we have fifteen, full four year scholarships this academic year for our medical school with contributions from Hawaii Pacific Health and the Queen’s Medical Center that are being matched by the Barry and Virginia Weinman Foundation. Discussions will continue with Kaiser and with the health systems for potential contributions to future medical school scholarships in hopes to keep these a recurring support for medical education.

NA.

Current legislative update is as follows:

a. The Family Medicine (FM) program did not receive the grant in aid request but was successful in working with Representative Sylvia Luke and others to allocate $1M in state funding to the Department of Health budget with verbiage allocating the monies specifically for the relocation of the Family Medicine clinic from Mililani to the Pali Momi Pavilion (same location as the UHP OB clinic). Representative Luke commented on how this relocation is an important step in developing the training environment needed for the FM outpatient clinic which directly ties into addressing the physician shortage of the state. The next steps will be ensuring the monies get released from the DOH to JABSOM for the FM program needs.

b. SB2298 is the preceptor tax credit bill that was modified from its original version and now only includes physicians, APRNs and pharmacists. It is being reviewed by the conference committee this morning.

c. SB2891 establishes another telehealth pilot program which is expected to pass.

d. SB2407 relating to medical cannabis to treat opioid addiction has been amended into a different bill that passed out of the Health Committee. The revised bill now calls for a study group to further look into the medical cannabis law. This bill is headed to conference committee.

e. The Hyperbaric Treatment Center (HBT) experienced a glitch with funding last session due to a lack of verbiage demonstrating a public purpose. The verbiage has been since corrected and funding is expected to be released. The grant in aid application was also denied.

3. Medicaid update

Efforts will continue to obtain funding from private and public sources as there is a high need for this service in the state.

a. Hawaii’s Medicaid program has operated under the Medicaid section 1115 demonstration waiver since 1994, which is renewed every 5 years. The purpose of these demonstrations, which give states additional flexibility to design and improve their programs, is to demonstrate and evaluate state-specific policy approaches to better serving Medicaid populations. Hawaii’s Medicaid programs do not impose a work requirement.

c. The framework is holistic: “A multigenerational, culturally appropriate approach that invests in children and families over the life-cycle to nurture well-being and improve individual and population health outcomes.”

f. Workforce capacity needs to be increased in primary and behavioral health care, team based and integrative care. There will need to be an increase in community health workers, as well as increased utilization of telehealth and telepsych services.

h. Timeline: New waiver period starts 1/1/19 when the re-procurement process for the managed Medicaid process will resume. Focus will be on increased integration, different payment models, investing in primary care and social determinants and focus on MCO/community initiatives. There will also be continued work on developing multi-payer shared projects to address high priority health needs.

4. Physician Workforce
Kelley Withy

Data and Maps update. Crystal to coordinate working group meeting.

a. Information and data shared was from 2017 and depicted by county.

b. The Council’s recommendation was to include reference points for maps such as physicians per population per county to help build an accurate picture of the need per location, include national level items and patients per population so comparisons can be made, and consider including side by side maps for easy visual interpretation of data.

c. Need to reevaluate slides and get a working group together to help process and better visualize the data. Volunteers for working group include: Linda Rosen, Lisa Rantz, Allen Hixon, Kenneth Robbins, Mary Antonelli, Lee Buenconsejo-Lum and Holly Olson.

5. Next Steps
L. Buenconsejo-Lum

a. Determine a common definition for workforce (similarly to how the Chamber of Commerce is discussing the definition of the medical home). Possible ways to determine this common definition include creating a short questionnaire to poll HMEC members. We could also review and compare the definitions of various stakeholders to get a better baseline understanding for everyone. This could include but is not limited to definitions from: Medicaid, VA, TAMC, HMSA, DOH, JABSOM and the Legislature.

b. Other groups are also working on neighbor island health workforce initiatives and would like to partner with HMEC, including Dr. Sydney Tatsuno and the Hui Kahu Malama program which works with the UH Internal Medicine residency program on primary care electives.

c. A next step will be to expand and create a subcommittee under HMEC to further address the HMEC recommendations #1 and 2 (below), including workforce challenges for the neighbor islands.

d. Population health, prevention and inter-professional education (IPE) assessments are being compiled. We still need to determine what data is most relevant and actionable GME faculty and residents, what is currently being done in GME programs and in conjunction with health systems, and expand existing curricula to include various entities that has already expressed a commitment to assist: HMSA, HHP, QCIPN, and Kaiser.

e. In relating to preventing burnout and promoting well-being, we conducted a well-being inventory across the school (GME & UME) and identified gaps and opportunities to expand curriculum (in coordination with health system initiatives as appropriate). It will be important to train residents/fellows in the models of practice that they will likely be working in. Dr. Szuster, the HRP Resident Resource, conducted a resiliency training series for the Pediatrics and Psychiatry programs. Feedback was overall positive, but with concerns that techniques could not be applied if faculty were burnt out and/or the learning environment did not allow for use of these techniques. To address this and with the aim of true culture change, we have contacted Dr. Ronald Epstein from the University of Rochester to conduct Mindful Practice training for key faculty leaders. Training would be over 2 days with an additional 4 moderated online training sessions. This will occur in February 2019. To minimize costs, we have discussed having Dr. Epstein do the training in Honolulu, along with Dr. Szuster. This would allow 60 attendees for the fraction of the cost and time than if they were sent to a 5-day intensive training in New York. The cost is estimated at $46K for all participants. JABSOM has some funding but would like co-sponsorship by the teaching hospitals and other stakeholders. The goal is to create a nucleus of change agents who are hospital/GME leaders who could then work with others to improve the environment of learning and other organizational changes to reduce the risk for burnout of health professionals.

Recap of 2018 HMEC recommendations to legislature (Lee will continue to seek input from HMEC members and provide updates at future meetings.):

1. RECOMMENDATION #1: UH JABSOM/HMEC recommends that UH JABSOM and the legislature work with vital stakeholders to identify options for funding GME and the return on investment to the state of Hawai‘i in funding GME.

2. RECOMMENDATION #2: UH JABSOM/HMEC recommends that the 2018 State Legislature assess the advisability and feasibility of an annual GME Appropriation to fund HMEC designated residency/fellowship programs with a particular emphasis on primary care.

3. RECOMMENDATION #3: UH/HMEC recommends that the 2018 State Legislature and State Executive Branch support the State Department of Human Services and UH JABSOM to work together to develop a State Medicaid GME Matching program to augment GME funding.

4. RECOMMENDATION #4: UH/HMEC recommends that the 2018 State Legislature, UH JABSOM, the Hawai‘i Medical Association and other stakeholders explore potential remedies or reforms to protect residents and fellows from being named in malpractice suits while they are in a formal training program and providing care under the supervision of a fully licensed attending physician.